A mobile health technology (mHealth) program that implemented the Atrial Fibrillation Better Care (ABC) pathway was found to reduce significant clinical adverse events in elderly patients with atrial fibrillation (AF) and multimorbidity compared to to usual care. The results of the study were published in JAMA network open.
The Mobile Health Technology for Improved Screening and Optimized Integrated Care in Atrial Fibrillation (mAFA-II) trial was a prospective, cluster-randomized trial conducted at 40 centers in China between 2018 and 2021. Older patients with AF were recruited from centers, where they were randomized. assigned to receive the intervention (patients: n = 833; centers: n = 20) or usual care (patients: n = 1057; centers: n = 20). The intervention included (A) evaluation of anticoagulation to prevent stroke, (B) better symptom control through medication adjustment, and (C) management of cardiovascular disease and co-morbidities by monitoring arterial pressure. The primary outcome measure was the composite incidence of stroke or thromboembolic events, all-cause mortality, and readmission to hospital.
The intervention and control cohorts had a mean age of 72.0 ± 12.0 and 72.8 ± 13.0 years; 33.4% and 41.9% were women; and the mean follow-up time was 419 ± 257 and 457 ± 154 days, respectively.
The composite primary outcome measure occurred less frequently in the intervention cohort (hazard ratio [HR]0.37; 95% CI: 0.26 to 0.53; P <.001>
Stratified by event, risk of rehospitalization (RR: 0.42; 95% CI: 0.27-0.64; P P = 0.002) decreased in the intervention cohort, but not the risk of mortality (RR: 0.52; 95% CI: 0.27-1.00; P = .06).
In the subgroup analyzes, the intervention was preferred for men and women, patients aged 75 or over or over 75, and with or without previous stroke to decrease the risk for the endpoint. composite primary judgment (all P <.001 and rehospitalization>P £ 0.02).
This study had limited power to assess some of the study’s results, and the cohorts were unbalanced due to its cluster design.
“In this predefined adjunct analysis of the mAFA-II trial, an integrated care approach based on mHealth technology that facilitates the implementation of the ABC pathway reduced significant clinical adverse events in elderly patients with AF and AF. multimorbidity compared to usual care ”, the authors of the study noted.
Disclosure: Several authors have declared affiliations with the industry. Please refer to the original article for a full list of disclosures.
Yao Y, Guo Y, Lip GYH et al. The effects of mHealth technology-supported pathway implementation on atrial fibrillation-related adverse events in patients with multimorbidity: the mAFA-II randomized clinical trial. JAMA Netw Open. 2021; 4 (12): e2140071. doi: 10.1001 / jamanetworkopen.2021.40071